| NPI | 1376639435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: OR OR MD14945) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: WA WA MD00034771) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |